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26 September 2008

Superinfections and superdrugs

I slept badly last night, because Kyrie did. Despite two powerful pain medications, medical grade honey, and lydocaine spray, her MRSI lesion caused her so much pain that she whimpered and cried for hours.

Twenty-four hours ago, nothing. This morning? What you see in that photo. That's how fast it hits.

This morning we went to the vet. The appointment was originally to check and make sure Rebel's MRSI bladder infection had been eradicated by his cut-short-by-severe-side-effects course of chloramphenicol. The vet added Kyrie to the schedule when I called last night and told her the monster was back. She had, coincidentally, just gone to a lecture by a local dermatology specialist to discuss the treatment of MRSI infections. She clipped Kyrie's fur and cleaned her wound, and took a sample to culture. She put her back on the antibiotic that cleared it last time, pending the culture results, and refilled Kyrie's painkiller prescriptions.

She took a urine sample from Rebel, too, and then I gave them four hundred bucks and took my dogs home.

I feel like I have no faith in anything anymore. Not holistic medicine, not conventional medicine, not the cutting edge, not the laying on of hands. I looked at Rebel's last culture and sensitivity test results. This bug is susceptible to nothing except drugs that quite literally cost thousands of dollars. And it's not just the money, because as long as they don't find some reason to wiggle out of paying, Rebel does have pet health insurance.

No, it's because these drugs? They're supposed to be reserved for the worst of the worst infections in human medicine, not being turned to by desperate dog owners because of what should have been mild, easily treated skin and bladder infections. They're supposed to be for the kind of infections you only pick up in an organ transplant unit.

And I just keep asking myself: what on earth is going on here? How is this happening?

I also keep wondering: why my dogs? Why us?

Forgive me my brief wallow in self-pity. There's nothing I hate more than seeing one of my dogs suffer, and not being able to find a cure.

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And I just keep asking myself: what on earth is going on here? How is this happening?

I also keep wondering: why my dogs? Why us?

You aren't wallowing in self pity - you are trying to figure out what is going on and is there anything you can do to stop it!

Staph is everywhere just like tetanus. There are Hospitals that are overrun with it and others that aren't. I would probably try to find some of that new cleaning stuff they tested at one of the hospitals - that worked on MRSI and clean everything. literally. Especially anything that the dogs come in constant contact with. People are told to wash their hands etc but dogs can't keep their tongues to themselves :-) We know they will lay and roll in anything! Good luck with the fight.

Sigh, Kyrie and Rebel are the unwitting victims of decades of antibiotic misuse by doctors willy-nilly prescribing them for viral infections like colds, and then the recipients of the medications not following thru with the dosage directions. The bacteria have evolved defenses against all but the rarest, most expensive and probably dangerous drugs due to their side effect or what might be called the neutron bombs of our current pharmacopoeia. Kyrie and Rebel did nothing more than walk in their community, and picked up these aerobes from the environment.

I am so very saddened that your grand dogs have to suffer like this. I wish I could wave a magic wand for them and you and make it all better.

Thanks, everyone, for your kind words! I was very low last night when I wrote that, but I'm feeling a bit brighter today.

Kyrie is nauseated on the chloramphenicol, but the wound is far better and seems no longer to be painful -- we've stopped the lydocaine spray and when I apply a fresh bandage, she doesn't pay any attention whereas before she would whimper and flinch, no matter how careful I was.

It has been very interesting to compare the very minor improvement from the honey when I applied it to a new, spreading, "hot" lesion, without accompanying antibiotics, compared to how it worked when I used it at the end of a course of antbiotics at the very first sign that the lesion was coming back (her hair was already shaved at that time, so I caught it within an hour of it starting to flare back up). It reinforces my hypothesis that you need to treat systemically AND topically, not just one. But the honey did help -- just not enough to even make her comfortable.

Something else I am struck with again is how very painful this condition is.

As to the nausea from the drug, we started her today on Zofran (and let's talk about cost, shall we?), and as far as I can tell from one day, it's made a huge difference. If only it didn't cost, you know, a bazillion dollars, I'd consider it a wonder drug.

Macrodantin is not well tolerated in dogs -- tends to cause massive GI upset. I've tried a few urinary antiseptics -- standardize cranberry, D-Mannose, uva ursi -- but they either make him incontinent or upset his stomach violently.

As to underlying causes: Rebel has Cushings, which predisposes to UTIs, and had to have surgery for a genetic kidney defect, which has the same effect, but those UTIs are usually simple e. coli infections from fecal contamination of his surgically-created urinary opening, and they're easily treated. This is something else entirely, a "simple" but almost-impossible-to-treat infection. Remember -- urine is supposed to be STERILE, and bladder infections are not opportunistic the way skin, digestive, vaginal, etc. infections are. They are true INFECTIONS by invading organisms.

Kyrie, on the other hand, must have some underlying problem or I agree, this wouldn't be happening. Either that, or the conventional wisdom is wrong, and these bugs are actually more virulent and pathogenic than their non-resistant cousins.

Both of my dogs had perfectly normal ... solidly normal... thyroid results from a comphrensive panel. Since you cannot just "give them" thyroid medication, but have to get it prescribed by a vet, and I'm not at all sold on that as the cause of Kyrie's woes to the point of vet-shopping or trying to change their minds, I haven't tried that yet.

Other than this problem, Kyrie has NO symptoms of hypothyroidism. She is lean, active, and has never been sick a day in her life. I've researched hypothyroidism and I really think, whatever her underlying problem is, that's not it.

My heart just aches for you. One infected dog is bad enough, but two is just unimaginable. Is there anything you can give them to boost their immune systems? I know that interferon is sometimes used in people with conpromosed immune systems, but I don't know if this is an option for dogs.

My granddaughter came home from the hospital with MRSA and has had to fight abscesses off and on all 17 months of her young life. This infection is awful and heartbreaking, especially when it attacks a loved one who depends on you for their well-being. You can do so little to ease their pain. :(

Two topical MRSA eradication regimes were compared in hospital patients: a standard treatment included mupirocin 2% nasal ointment, chlorhexidine gluconate 4% soap, silver sulfadiazine 1% cream versus a tea tree oil regimen, which included tea tree 10% cream, tea tree 5% body wash, both given for five days. One hundred and fourteen patients received standard treatment and 56 (49%) were cleared of MRSA carriage. One hundred and ten received tea tree oil regimen and 46 (41%) were cleared. There was no significant difference between treatment regimens (Fisher's exact test; P = 0.0286). Mupirocin was significantly more effective at clearing nasal carriage (78%) than tea tree cream (47%; P = 0.0001) but tea tree treatment was more effective than chlorhexidine or silver sulfadiazine at clearing superficial skin sites and skin lesions. The tea tree preparations were effective, safe and well tolerated and could be considered in regimens for eradication of MRSA carriage.

The boyfriend of an acquaintance is currently fighting for his life at the Stanford Medical Center because of a sore spot on his back that has turned out to be a virulent bacterial infection. I'll spare you the gory treatment details, but he was told that if he had waited one more day to see a doctor he would have been dead.

What is going on indeed!? This is crazy. Creepy that these infections are seeming to come out of nowhere.

Stay on it Christie and I hope Rebel and Kyrie get well soon! My thoughts are with you and them.

I don't know what you think of this idea, I've seen Traditional Chines Medicine treat people conditions with success that conventional medicine won't make a dent in. In Illinois animal acupuncturists are also DVM's. In South Korea etc. it's used on farm animals too. Should help with pain management, sleep and possibly herbs to kill infection.

These superbugs are everywhere. A recent study found MRSA on one-third of cellphones. Yet most of us, and most of our pets, don't get infected with them--we fight them off. So the question is--what is amiss with the dogs that makes them unable to fight off the infection? Two simple things to try: 1. Supplement with thyroid medication (T4), in case hypothyroidism is the cause. If there's no improvement in a few weeks, stop the thyroid medication. And remember, a dog (or person) can be hypothyroid and still have the thyroid lab tests come out normal. 2. Add pancreatic enzymes (Viokase, Pancrezyme, etc.) to the dogs' food, in case the dogs have pancreatic insufficiency or some other difficulty digesting food. These digestion problems can cause nutritional deficiencies because nutrients aren't adequately digested. And by all means, try the super expensive antibiotics. Good luck! This is hell to deal with.

Very interesting. I knew the Mupirocin was more effective than chlorhexidine but hadn't heard of using tea tree body wash as an alternative. As for Zofran, even generic is very expensive in my experience. Getting it at cost from a hospital that buys in bulk was still ~$20 for each 4mg pill.

Christie, do you know if any work is being done on a vaccine for staph, at least for the resistant varieties?

When we moved to Ukiah, we moved onto a former cattle/swine/poultry property that came loaded with wildlife and a very ornery strain of giardia as well as a very resistant species of cocidia. The first litter we raised here became sick the second they were exposed to the outside world.

I am obsessive about preventing exposure to infections in puppies so I was very upset and off to the vet we went. The local veterinarian was useless, told me it was my fault for not cleaning up properly and that I needed to eradicate the protozoans from my property with some bleach.

The critters are in the ground here. They have plenty of wild hosts to infect and use to procreate. We have artesian water resevoirs all over to help cysts summer easily. A Bleach ain't going to do it. A small nuclear blast and a biodome with all water brought in from a sterile source might.

Over the past 14 years we have accepted that most puppies will have a bout or two then they generally develop immunity. Some otherwise healthy dogs do not and we will then use the giardia vaccine which is not great but seems to help jumpstart the immune response and reduce the risk of future outbreak.

Vaccines against bacteria never seem to be as effective as those for virus caused ailments, but at least their development may offer hope to individuals who lack an adequate immune response to certain bacteria and if their use can drastically reduce the everyday use of antibiotics in humans and animals then they could be a large part of the key to slowing the evolution of superbugs.

Bernard, you're getting some basic facts wrong. The last time I disagreed with your recounting of the steps I took with her earlier infection, you admitted you hadn't clicked on the links, and you still have no idea what I did and didn't do.

Your statement that I ever said the honey "cured" Kyrie is just plain false. The reporter said that in the TV news report, but I never told her that, nor did I write it any of the several pieces I did based on the earlier incident. Kyrie was on ORAL antibiotics that every time she went on them, other than the initial prescription of cephalexin, cured the lesion. It returned, however, when the antibiotics were done, until the last time, when I also used the honey.

I have stated repeatedly that the key seemed to be the ADDITION of topical treatment and I never said the honey was unique in its ability to be that topical treatment. I have come to believe, based on further research and my experience, that it's essential to use both topical and oral treatment for skin MRSI infections. I have no idea why you can't seem to wrap your brain around that, since it's exactly what you're saying, too.

As to your opinion on where they get the infections, you're incorrect on the science of it. Kyrie is carrying MRSI, and there is some underlying problem in HER, not her environment, that has allowed it to proliferate, like any other staph will do when it has the opportunity, and get out of control. The problem is the host, not the bug.

With non-resistant staph, that's not the end of the world -- it's usually very easy to clear up. The question of why the dog's immune system allows that to happen remains, whether it was a resistant or garden-variety staph. She's not "carrying it home from the park," she's walking around with a certain percentage of the staph in and on her body -- which all dogs, and people, have, all the time -- having become this resistant strain. But it's still just staph.

When they go out and culture public telephones and the handles of doors in public buildings, they always find a certain amount of resistant staph (in this case, MRSA, not MRSI, which is a canine and feline strain and does not infect humans). That percentage is growing all the time, as more and more bugs trade genes for drug resistance. That's why I used the phrase "brave new world." Welcome to it.

As to why I don't have MRSI and the dogs do, it has nothing to do with my bathing habits, dude. It has to do with the fact that MRSI is a CANINE bug, not a human bug. Humans get MRSA... and I bet that a scary number of us, maybe even me, would, if cultured aggressively, turn out to have at least a few resistant staph bugs -- MRSA -- in and on our bodies.

But if I do, it's not making me sick because my immune system is fully functional. Something is wrong with Kyrie's or she wouldn't be getting these lesions.

Rebel, on the other hand, does not necessarily have any kind of immune problem, because his skin is fine. The urinary tract, unlike the skin, is supposed to be sterile. UTIs are not opportunistic like skin infections, vaginal infections, GI tract infections, etc. are. They are, if you will, "invasion" infections, as you seem to think Kyrie's is too, although you're wrong about that.

All that probably happened with Rebel is that Kyrie's bugs crawled up his urinary tract. Just like any bug could have... but in this case, we can't easily treat it. There's really no mystery with him, just a tragedy. If his immune system were compromised, he'd probably have a skin or eye or some other opportunistic infection. He doesn't.

The last time this subject came up I was given to believe that the medical honey had in fact cured the outbreak. Now you mentioned that some anitbiotic cured it. Which is it?

I would like to know how the antibiotics are being administered. Is this injected? If so, sub-cu or intra muscular?

Or is it a topical ointment?

If the former experience tells me that this is pretty worthless.

Direct application of some kind of anti-bacterial poltice is absolutely required. Medical honey is find but there are others.

All that being said, infections just dont materialize out of thin air. Your dogs are coming in contact with it from some source again and again. There is some source where they routinely go that has a source of this bug and when they go there it has enough time under their coat to get a foot hold and then its off to the races again.

You need to survey where the dogs have been. Knowing what conditions in soil or environment promote this particular bug and you may have to do some real scientific research to find it and then KEEP THEM OUT OF THERE!

Also consider that you are not getting this infection, right? But no doubt you take regular showers and wash your clothes. No doubt if you duplicated their activities and hygene you would fall prey too.

You asked, "Why [your] dogs". Bugs are opportunistic creatures. Your dogs may have coats that are particularly conducive to providing a home for them and as they go where they go and do what they do they keep meeting the same villians. These types of bugs do not like light hense the clipping. The fact that they have black fur does not help in prevention since it shields the bugs from the radiation.

There is no way to vaccinate or permanently cure a bacterial infection. It simply re-occurs because the events re-occur. Do your best to discover the source and practice near human like dog washing and bedding changes and perhaps you can prevent it happening again.

I watched one of those infomercials on TV this morning, this one on the Monster 1200 Steam cleaner. They tout it as killing 99.99% of germs including MRSA. Their secret isn't the steam although their unit has a more powerful steam blast, the secret is the oxygenated safe cleaning solution that is added to the steam from a special tank. They are an As Seen On TV product. What I found surprising was how easily they claim (and showed) it cleans. Perhaps a product like this will assist in further cleaning to eliminate MRSI bugs in the home and thus reduce chances of reinfection. They mention they will ship the cleaning solution free for life on the ad.

Well Christie, I knew when I submitted the original comment that you were likely to react badly as soon as I brought up the subject of hygene. It was not meant as a knock on your houskeeping or bathing habits so to that extent I am sorry.

I am also sorry that I dont buy the idea that she is "carrying" this but I dont. As pointed out by other people here this stuff is all over (eg public phones - do people still use them?) The fact that one dog gets it and the other tends not to (but did get it in at least one instance) may well be unique to this particular dog and may well be an imunity issue.

The question then becomes - what to do about it? What I was trying to suggest is that as a normal preventative in this situation is stepping up the hygene. Its not any different than what a hospital or your kid's school or a cruise ship would do when some bug breaks out. You have to break the cycle of infection.

If this really is an imune system issue then all the hype and hand wringing over MRSA and a supposedly toxic local environment is totally pointless. Obviously the streets are not piled high with dead animals (or people) so its a little difficult to accept the idea that some mutant strain of "super" bug is eating all the dogs its just eating this particual dog.

It does not have to be an imune system issue at all to get this same result. All it would take is some slight difference in her skin that makes a more inviting environment for the bugs. Perhaps her skin is too oily making an attractive medium in which to grow? Or, it may be the opposite where the waxy coating dogs often get isnt there allowing the bug to get into her pores.

In fact, your arguement seems to be going in both directions. One one hand you state that she is "carrying" the disease and then turn right around and point to a neighborhood environment that sounds like a superfund candidate. So, which is it? Is she the source or just a repeat victim of the locale? I suspect its the latter.

You mentioned your other dog's urinary infection stating that he got some of her bugs. Yet there is no scientific way to prove that. It is far far more likely that he picked them up from the same source that you yourself identified as being pervasive in the region. Dogs are low to the ground, they like getting into dirt and unlike kids, dont get tossed into the tub and given clean clothes after a day of making mud pies. And THAT (or something like it) is all I suggested and nothing more.

If it really is the environment you have few choices. You can become ever vigilent on keeping her super-clean and restricting her outdoor activities or you can get her out of there. If you cant move you may have to find her a new home or if you think this is affecting other dogs (sic your reference to other sick litters) and you are committed to raising dogs then you might want to call the realtor. (lotsa luck in the current market...)

Under any other circumstances an individual weakness to an environmental risk is how natural selection works. It would seem that you are at odds with nature on what selections should be made. If you are right about the nature of the environment there then you are fighting a loosing battle which will end badly for Kyrie. Ranting on and on about some supposed super bug over which you have no control or trying to become an amateur pharacist is not going to result in much consolation if it takes her life.

I posted on another topic that local critters often have something to say about suburban development projects. It certainly sounds like they are trying to send you a message and the go-away sign is out. If you love this dog, and I think you do, you have some hard choices to make.

Im sure all the sultry details of the science she digs up is true enough. The question is, how is this going to help the dog?

If you don't understand where the infection is coming from--if, for instance, you cling blindly to the idea that a bug that's normally present in most humans and most dogs, but normally controlled by a healthy immune system, must in its pernicious form be coming from "the environment," why then, you can spend all your efforts futilely attempting to correct a "hygiene" problem when what your really have is a combination of an unhealthy immune system and a drug-resistant variant.

And that doesn't help the dog. That could in fact make the dog more miserable (don't know about Kyrie, but my dog hates her baths) while doing nothing to control the infection.

It's like refusing to acknowledge the difference between demodex and sarcoptic mange. Yes, they're both "mange," but the implications for correct care are very different, and what counts as a "successful" outcome, are quite different.

Good science is based in reality and has practical application. If it does not serve life in the real world then it isnt science at all or at least is mis-applied.

If her back yard is as bad a bio-hazard as she states then making scientifically unsupportable claims of carrying an alleged superbug arent serving anyone except to externalize the source of Kyrie's problems.

There is no folk wisdom in what I am suggesting. Rather it is the assertion that after all is said and done, the simplest explanations tend to be the correct ones.

I have a natural aversion to "modern" veterinary practice mgt which tend to go for the high tech solutions first. In my opinion, they tend to be the high priced (read: billing opportunity) solutions which may not in fact be the best solution at all.

Superbugs became super bugs because the first reaction of medical practioners for the last 80 years has been to throw antibiotics at them as a substitution for good management. This INCLUDES the ag industry which continues to foolish pump things like Terramycin into animal feed because it helps them survive large scale feed lots which is routinely defended by DVMs without appology.

The only solution to this is to stop high density large scale feed lots thereby extracting the animals from the source of their stress and infection. The only practical solution for a dog like Kyrie is to extract her from the environment that is making her sick.

Im sure all the sultry details of the science she digs up is true enough. The question is, how is this going to help the dog?

Is Christie going to discover some solution to the evolution of staph that defeats drug after drug? Hardly. Science is what it is and there is no harm in trying to understand the mechanics of the malady. But at the end of the day you have to make a judgement as to just exactly what all that detailed knowledge is going to do for you.

Being technically correct is only of value if you dont mind your pet being technically dead.

Well Christie, I knew when I submitted the original comment that you were likely to react badly as soon as I brought up the subject of hygene. It was not meant as a knock on your houskeeping or bathing habits so to that extent I am sorry.

Bernard J. (Bernie) Starzewski

Hey Bernie, believe me Christie doesn't need someone else to speak for her. But as an observer, I can guess that your discussion of potential hygiene issues had nothing to do it.

You have the amazing ability to flip-flop, citing "science" without citations when you feel like it, and trashing "science" in favor of "old-fashioned wisdom" when it doesn't suit your argument.

I have never known Christie to argue anything she couldn't support with peer reviewed science, including citations and often interviews with those scientists.

You have a tendency to act as if because you've had livestock and live in a rural area -- and we're just city-living idjits -- you know every thing there is to know.